Enrollment for State & Local Retirees & Continuants

Please complete all fields. Optional fields are indicated.

If you are a local employee applying for continuant coverage, please contact your former employer.

If you are already enrolled and want to cancel or change your enrollment, please complete and return the Dental Plan Change form.

Enrolling in the supplemental plans as a Retiree or Continuant is dependent upon final approval by the Wisconsin Department of Employee Trust Funds.

If you are unsure if you qualify please contact the appropriate agency.

Retirees, call WI ETF 1-877-533-5020.

Continuants, contact your HR department.